A comparative study of nerve-sparing techniques in open radical prostatectomy: Antegrade versus retrograde

Abstract

Aim: To compare perioperative, oncological, and functional outcomes between antegrade and retrograde nerve-sparing techniques in open radical prostatectomy (ORP).

Materials and Methods: This retrospective study included 278 patients who underwent open radical prostatectomy (ORP) performed by a single surgeon between 2016 and 2025. Patients were divided based on the nerve-sparing approach: antegrade (n=90) or retrograde (n=188). Demographic characteristics, perioperative variables, pathological outcomes, biochemical recurrence (BCR), urinary continence, and erectile function were evaluated. Multivariable logistic regression analysis was used to determine independent predictors of BCR.

Results: Retrograde ORP demonstrated a shorter operative time compared with the antegrade technique (151.1 vs. 166.5 minutes, p<0.001), whereas the antegrade group was associated with lower intraoperative blood loss (437 vs. 517 mL, p=0.047). Biochemical recurrence was significantly higher in the antegrade group (33.3% vs. 18.8%, p=0.008). Postoperative functional outcomes, including urinary continence (p=0.524) and erectile function (p=0.230), were comparable between the groups. In multivariable logistic regression, the retrograde approach independently reduced the risk of biochemical recurrence (OR 0.38; 95% CI: 0.19–0.76; p=0.0058).

Conclusion: It is evident that both techniques are safe and effective in ORP. The retrograde approach was associated with more favourable oncological outcomes, whereas the antegrade technique provided better intraoperative hemostasis. The choice of surgical approach should be individualized based on tumor characteristics and surgeon expertise.